Individual
CARLY RAE ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
5165 MCCARTY LN, LAFAYETTE, IN 47905
(586) 665-6500
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
02007318A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1103105712
ANTHEM PTAN
IN
05
—
300079318
—
IN
Enumeration date
04/19/2019
Last updated
05/07/2025
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